Provider Demographics
NPI:1003363870
Name:HRUZ, JENNIFER HIDALGO
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HIDALGO
Last Name:HRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ELAINE
Other - Last Name:HIDALGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1428 E RACINE AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-6462
Mailing Address - Country:US
Mailing Address - Phone:262-832-8888
Mailing Address - Fax:262-806-0028
Practice Address - Street 1:2355 S KRAHN RD
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-2935
Practice Address - Country:US
Practice Address - Phone:414-248-3394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2016013734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily